KITSAP COUNTY FIRE MARSHAL OFFICE COMPLAINT FORM
614 Division Street MS-36, Port Orchard WA 98366-4682
(360) 337-7181

Please note that this information will be kept confidential.
If you have any questions regarding this policy, please contact KCFMO at (360) 337-7181.

Type of Complaint or Referral  (select at least one - use the Control key to select more than one type of complaint)

          

ALLEGED VIOLATOR INFORMATION    Please enter as much information as you know.

Name or Business Name:
Site Address:
Owner/Manager:
Mailing Address:
Building Owner:
Address:
Phone or Bus. Phone:
Evening Phones
Assessor's Account #:
Directions to site:

VIOLATION

Fire Code Section(s) if known:
Nature of Violation or Complaint:
Details of corrective actions or efforts made so far:

(OPTIONAL) COMPLAINANT INFORMATION (person submitting this complaint)
If provided, this information will be kept confidential.

Name:
Address:
City, State, Zip Code:
Phone: Home   Work  
E-mail address:

REFERRED BY (Optional) (Referring Fire District or other agency use only)

Name: 
Phone #:
Agency:
E-mail address:

Last updated: August 14, 2007